A corneal ulcer is an open sore on the cornea, which is the clear, outer layer at the front of the eye. It occurs when the surface of the corneal epithelium becomes damaged, causing an open wound that can lead to pain, redness, light sensitivity, and blurred vision.
The most common cause of a corneal ulcer is prolonged contact lens use or poor lens hygiene. These factors can cause inflammation of the cornea, called keratitis, which weakens the surface and allows bacteria, viruses, fungi, or parasites to enter and cause infection.
Treatment for a corneal ulcer is guided by an ophthalmologist and varies depending on the cause. It may include antibiotic, anti-inflammatory, corticosteroid, antifungal, or antiviral eye drops or ointments.
Corneal ulcer symptoms
The main symptoms of a corneal ulcer include:
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Severe eye pain;
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Feeling like there is sand or grit in the eye;
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Persistent eye redness;
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Excessive tearing;
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Pus or discharge from the eye;
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A white spot on the cornea;
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Blurred or cloudy vision;
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Sensitivity to light;
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Swelling of the eyelids;
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Difficulty opening the eyes.
It’s important to see an ophthalmologist as soon as symptoms appear so the condition can be diagnosed and treated promptly. Early treatment helps prevent complications such as corneal scarring, perforation, vision loss, or blindness.
Confirming a diagnosis
A corneal ulcer is diagnosed by an ophthalmologist based on the person’s symptoms, when they started, medical history, contact lens use, eye trauma, prior eye surgeries, or the use of immunosuppressive medications.
To confirm the diagnosis, the doctor performs an eye exam that may include checking intraocular pressure, testing visual acuity, and using a slit-lamp microscope to assess the size and location of the ulcer.
To determine whether the infection is caused by bacteria, viruses, or fungi, the doctor may collect a small sample of corneal tissue for laboratory analysis. A Seidel test may also be performed using an anesthetic eye drop and fluorescein dye to detect corneal perforation.
Possible causes
The most common causes of a corneal ulcer are infections from bacteria such as Staphylococcus aureus or Pseudomonas aeruginosa, viruses such as herpes simplex, fungi such as Aspergillus or Candida species, or protozoa such as Acanthamoeba, found in contaminated water.
Certain factors can increase the risk of developing a corneal ulcer, including:
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Prolonged contact lens use;
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Poor cleaning or improper handling of contact lenses;
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Swimming or showering while wearing contact lenses;
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Keratitis, blepharitis, or recent eye injury;
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Previous eye surgery;
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Corneal abrasions or burns;
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Use of corticosteroids or contaminated eye drops.
Autoimmune disorders such as lupus or rheumatoid arthritis, collagen vascular diseases, vitamin A deficiency, and diabetes can also increase the risk.
In addition, dry eye syndrome or eyelid problems such as Bell’s palsy can cause excessive dryness that makes the eye more vulnerable to ulcers.
Treatment options
Treatment for a corneal ulcer should always be supervised by an ophthalmologist and varies depending on the cause, the severity of symptoms, and the size of the lesion.
1. Use of medications
The first treatment option for a corneal ulcer usually involves antimicrobial eye drops or ointments.
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Bacterial infections: antibiotic eye drops such as ciprofloxacin or ofloxacin are commonly prescribed.
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Viral infections: ganciclovir 0.15% ophthalmic gel (Zirgan) is the FDA-approved topical antiviral, and oral antivirals such as acyclovir or valacyclovir may also be used as indicated.
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Fungal infections: antifungal eye drops such as natamycin or amphotericin B may be recommended.
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Acanthamoeba infections: topical polyhexamethylene biguanide (PHMB) or chlorhexidine, sometimes combined with propamidine or hexamidine, are typically prescribed.
Other medications that may be prescribed include anti-inflammatory eye drops such as ketorolac tromethamine or diclofenac sodium, which may help relieve discomfort.
Corticosteroid eye drops, such as prednisolone acetate or dexamethasone, may be used cautiously and only under specialist supervision, typically after at least 48 hours of effective antibiotic therapy, to reduce inflammation and minimize corneal scarring.
If the ulcer is linked to another medical condition, such as an autoimmune disease, it’s important to treat the underlying condition to prevent recurrence.
2. Surgery
Surgery for a corneal ulcer is usually performed through a corneal transplant, which replaces the damaged cornea with a healthy donor cornea. This procedure is recommended for people who continue to have scarring that affects vision even after proper treatment.
If the ulcer does not heal as expected and no underlying condition is found, surgery may also be considered.
Recovery time
The healing time for a corneal ulcer varies depending on the size, location, and depth of the ulcer.
In most mild cases, improvement occurs within 2 to 3 weeks, but treatment may continue longer to ensure no scar tissue forms that could affect vision.
For Acanthamoeba infections, treatment can take 6 to 12 months.
Signs of improvement
Signs that a corneal ulcer is improving include reduced eye pain, decreased redness, and clearer vision.
However, to confirm that the ulcer has fully healed, an ophthalmologist should evaluate the cornea during an eye exam.
Prevention tips
A corneal ulcer can often be prevented with proper eye care and hygiene. Important preventive measures include:
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Wearing protective goggles when using power tools or working in dusty environments;
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Using lubricating eye drops if you frequently have dry eyes;
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Washing hands thoroughly before handling contact lenses;
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Inserting and removing contact lenses correctly;
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Avoiding sleeping in contact lenses, especially after all-day use;
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Minimizing exposure to dust, smoke, or chemical irritants.
Because infections are one of the main causes of corneal ulcers, it’s also recommended to wash your hands regularly, especially before touching your eyes, to help prevent the spread of bacteria, viruses, or fungi.